Case Study 1
Because Mrs. Smith’s main reported symptoms are bilateral mild knee pain and some
sense of unsteadiness on walking. It is important to further asses and question her in other to
provide quality care. One must also understand that Intrinsic risk factors for falls include old age,
female gender, low body mass, medical comorbidities, musculoskeletal diseases, cognitive
impairment, gait and balance disorders, sensory impairments, postural hypotension, his-tory of
previous falls, use of certain medications such as benzodiazepines, sedative-hypnotic drugs,
antidepressants, antihypertensive drugs, antiarrhythmic drugs, diuretics, and antiseizure
medications In contrast, environmental hazards such as rugs, slippery or uneven floors, poor
lighting, electrical cords, chairs and armchairs without handrails, slippery surfaces, and
unsuitable footwear are often classified as extrinsic risk factors. Noticeably, many risk factors,
including advanced age, are related to both falls and reduced bone strength and are therefore
especially important for fracture risk. Risk factors for falls and fractures can also be divided into
modifiable and nonmodifiable factors, where both can be used as markers for future fall risk, but
only modifiable risk factors can be addressed by preventive strategies to reduce the future fall
risk. A history of falling is one of the strongest independent risk factors for additional falls. It is
therefore especially important to evaluate every elderly person attending healthcare with a fall.
This has been successfully utilized in the Prevention of Falls in the Elderly Trial in which
structured intervention decreased the future fall risk by 70 % in patients attending an emergency
department with a fall-related injury. (Karlsson, K., Magnusson, H., von Schewelov, T., &
Rosengren, E. 2015). It is also important to note Mrs. Smith’s weight. People who are obese fall
and injure themselves at a higher rate than those who are normal weight. Obese patients have an
increased risk for falls and fall-related injury, not just because of the loads involved, but also
because of the strategies they use to recover from a trip or slip. “People 65 years and older
makeup 13% of the US population but account for three-fourths of all deaths caused by falls. An
estimated 31% of individuals 60 years and older are obese.” (Gustavo, V. & Moraes, B. 2016). In
older adults and maybe even the general population, obesity may not appear to cause more
frequent slips or trips, but it does negatively affect the ability to recover balance and prevent a
fall compared with normal-weight people.
Interventions I would recommend to minimize her risk of would include physical
therapy, Using appropriate equipment, self-help devices, protective devices, environmental
intervention, home modification, exercise therapy, physical education, and training. Research has
shown that physical training programs, and then especially with compliant participants, reduce
the risk of falling in the elderly population. When seniors engage in certain prevention exercises
and activities, they likely decrease their risk of falling. Increasing strength, flexibility, and
balance likely help seniors improve stability and walking. Among the exercise programs, multicomponent exercise programs, that are training programs with different exercise modalities, is
the most effective fall prevention strategy in the general community living elderly population.
(Gustavo, V. & Moraes, B. 2016). This seems to be the only intervention strategy that reduces
both the number of individuals that fall and the fall rate in fallers. All other effective
interventions in the general population reduce only one of these two variables. Therefore,
exercise has been described as the most cost-effective strategy for preventing falls and fractures
in a community-dwelling older adult. In multicomponent exercise programs, the two most
important components seem to balance training and muscle strength training, followed by
flexibility and endurance training. Supervised group exercise, when at least including two
different training components, has been shown to decrease the rate of falls in this population.
Surgical treatment in specific risk groups with specific diagnoses can be an option to reduce the
number of falls. Most falls resulting in fragility fractures occur indoors, even more, evident in
individuals above age 65 and greater. In this group, it is therefore extra important to focus on
home safety through home hazard modification. Modification of home hazards in the general
elderly population reduces the number of falls.
Two strong determinants of fracture in the elderly are fall and bone fragility. The
prevention of falls is, therefore, one of the most important tasks for the healthcare system not
only to reduce the number of fractures but also other trauma-related injuries. Several physical
training therapies are efficient by research. The most effective approach to reducing both the risk
and rate of falls in elderly community-dwelling individuals is multi-component exercise
programs targeting strength, balance, flexibility, or endurance. Programs that contain two or
more of these components reduce the risk of falling as well as the rate of falls. Exercise in
supervised groups, participating in Tai Chi, and carrying out patient-specific exercise programs
at home are all effective. In institutionalized individuals, exercise training alone does not appear
to be effective to prevent falls and fractures, except for in persons in a sub-acute care hospital
setting. Home hazard assessment with modification of risk factors has been proven efficient for
community living elderly with the most obvious beneficial effect in high-risk groups. Anti-slip
shoe devices are effective for fall reduction in elderly walking outdoors in icy conditions.
Reference
Karlsson, K., Magnusson, H., von Schewelov, T., & Rosengren, E. (2015). Prevention of falls in
the elderly a review. Osteoporosis International, 24(3), 747-62.
Gustavo, V. & Moraes, B. (2016). Falls in elderly people. The Lancet, 367(9512), 729-30.